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      Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation Translated title: O ultrassom substituirá o estetoscópio?: relato de caso sobre ventilação monopulmonar neonatal

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          Abstract

          Background and objectives

          One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position.

          Case report

          We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound.

          Conclusion

          US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

          Resumo

          Justificativa e objetivos

          A ventilação monopulmonar e a intubação seletiva em recém-nascidos podem ser um desafio devido às especificidades fisiológicas intrínsecas e ao material disponível. O aparelho de ultrassom tem sido cada vez mais usado em muitas situações no campo da anestesia, incluindo a confirmação da posição do tubo endotraqueal.

          Relato de caso

          Apresentamos o relato do caso de um recém-nascido proposto para lobectomia pulmonar por toracoscopia em que a exclusão pulmonar foi confirmada por ultrassom.

          Conclusão

          O ultrassom é um método rápido, mais sensível e específico do que a ausculta para avaliar a intubação traqueal e a exclusão pulmonar.

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          Most cited references5

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          Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis.

          This study aimed to undertake a systematic review and meta-analysis to summarize evidence on the diagnostic value of ultrasonography for the assessment of endotracheal tube placement in adult patients.
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            One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

            The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ‘One lung ventilation for infants and children’, ‘Video assisted thoracoscopic surgery for infants and children’, and ‘Physiologic changes during one lung ventilation for infants and children’ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH) eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.
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              A prospective randomized controlled double-blind study comparing auscultation and lung ultrasonography in the assessment of double lumen tube position in elective thoracic surgeries involving one lung ventilation at a tertiary care cancer institute

              Background As lung ultrasound (LUS) can be used to identify regional lung ventilation and collapse, we hypothesize that LUS can be better than auscultation in assessing lung isolation and determining double lumen tube (DLT) position. Methods A randomized controlled study was conducted in tertiary care cancer institute from November 2014 to December 2015, including 100 adult patients undergoing elective thoracic surgeries. Patients with tracheostomy, difficult airway and pleural-based pathologies were excluded. After anesthesia induction and DLT insertion, patients were randomized into group A (auscultation) and group B (LUS). Regional ventilation was assessed by experienced anesthesiologists using the respective method for each group. Final confirmation of DLT position with a bronchoscope was performed by a blinded anesthesiologist. Contingency tables were plotted to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each method. Results Data from 91 patients were analyzed (group A = 47, group B = 44). Compared with auscultation, LUS had significantly higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P = 0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P = 0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P = 0.101) and area under curve (0.748; 95% CI: 0.604–0.893 vs. 0.554, 95% CI: 0.379–0.730; P = 0.109) were not significant. Conclusions Compared to auscultation, LUS is a superior method for assessing lung isolation and determining DLT position.
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                Author and article information

                Contributors
                Journal
                Braz J Anesthesiol
                Braz J Anesthesiol
                Brazilian Journal of Anesthesiology
                Elsevier
                0104-0014
                2352-2291
                05 September 2019
                Sep-Oct 2019
                05 September 2019
                : 69
                : 5
                : 514-516
                Affiliations
                [0005]Hospital de Braga, Braga, Portugal
                Author notes
                [* ]Corresponding author. adriana.acsr@ 123456gmail.com
                Article
                S0104-0014(19)30083-1
                10.1016/j.bjane.2019.07.002
                9391872
                31630850
                257029d3-beef-440c-92b2-aebffb49b152
                © 2019 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 20 April 2019
                : 29 June 2019
                Categories
                Clinical Information

                neonate,lung ultrasound,one-lung ventilation,video assisted thoracoscopic surgery,recém-nascido,ultrassonografia pulmonar,ventilação monopulmonar,cirurgia toracoscópica assistida por vídeo

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